380 MEDICAL JURISPRUDENCE there is usually feeble-mindedness leading to progressive dementia of the most degraded character. True epileptic insanity is that which is associated with epileptic fits. This may occur before or after the fits, or may replace them, and is known as pre-epileptic insanity, post-epileptic insanity and masked or psychic insanity. I. Pre-Epileptic Insanity.—This is very common and may replace the epileptic aura, lasting in some cases for hours or even days. It is charac- terized by violent fits of maniacal excitement or by depression, fussiness, suspiciousness and general malaise. Hallucinations of various kinds are experienced and, owing to delusions, the patient may commit violent assaults, or may bring false charges against innocent persons. Sometimes, the patient may refuse to take any food. II. Post-Epileptic Insanity.—In this condition stupor following the epileptic fit is replaced by automatic acts of which the patient has no recollections. The patient is confused, fails to recognize his own relatives, and wanders aimlessly about. He is terrified by visual and auditory hallu- cinations of a religious character and delusions of persecution, and consequently may commit crimes of a horrible nature, such as thefts, incendiarism, sexual assaults and brutal murders. Such crimes are motiveless and unpremeditated. The patient never attempts to conceal them at the time of perpetration but, on regaining consciousness, may try to conceal them out of fear. In a murder trial at Lancashire Assizes on October 30, 1928, evidence was given by mental specialists who suggested that the accused had killed his wife in a condition of post-epileptic automatism. He fired shots at his wife and killed her outright. There was evidence that at the time his manner was calm and deliberate and he appeared to' know perfectly well what he was doing. In 1922, he had suffered from petit mal and he was suffering from a condition of post-epileptic automatism in which a man might do- things about which he seemed quite able to reason though entirely unconscious of what he had done. The jury found that the accused was guilty of the act charged but insane at the time.9 A case is recorded in which the accused murdered his mother and wounded his step-father in a fit of epilepsy without any apparent cause and then hid himself in a ravine. The medical evidence showed that the accused was subject to epileptic fits and he used to be completely unconscious during such time. It was, therefore, held that the evidence of this unprovoked attack upon his mother and step-father with whom he had no quarrel or trouble, and his hiding in the ravine were certainly consistent with the attack upon the deceased having taken place during or whilst recovering from an epi- leptic fit and that any other theory of the events was really untenable. It was found that the accused was guilty of the acts charged but not so as to be responsible in law for his actions. He was detained during His Majesty's pleasure.10 In some cases violent gesticulations or fits of mania may develop after sleep usually following the epileptic seizures. This condition is quite transitory, lasting for a few hours. In a very small number of cases mental depression may follow the epileptic fits, and may be accompanied by delusions of persecution leading to suicidal or homicidal tendencies. III. Masked or Psychic Epilepsy.—In this variety the epileptic seizure is replaced by the transitory loss of consciousness and maniacal excitement. It is interesting from a medico-legal point of view, for a patient suffering from this condition is apt to commit a criminal offence without any con- sciousness or premeditation and without any subsequent remembrance of the act. Lastly, it should be remembered that epilepsy in childhood may arrest the growth of the mental faculties, and lead to idiocy and imbecility. 9. Lancet, Nov. 10, 1928, p. 990, 10. Rangoon H. C. Cr. App. -No. 1397 of 1936, NGA ANT BWE v. K. E., 38 Cr. Law Jour., 1937, p. 667.